THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
You may download a copy of the United States Department Health and and Human Services Summary of the HIPAA Privacy Rules.
If you have any questions about this Notice, please contact Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046 (781) 646-4345.
Our Pledge Regarding Health Information
Arlington Family Practice, P.C., is committed to protecting medical information about you. This Notice describes the Group’s privacy practices and that of all its affiliate sites, all employees, staff, volunteers and other personnel.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
Make sure that medical information that identifies you is kept private;
Give you this Notice of our legal duties and privacy practices with respect to medical information about you; and
Follow the terms of the Notice that is currently in effect.
How We May Use And Disclose Health Information About You.
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at a Arlington Family Practice, P.C. facility. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.
For Payment. We may use and disclose medical information about you so that the treatment and services you receive at a Arlington Family Practice facility may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a procedure you received at a Arlington Family Practice facility so your health plan will pay us or reimburse you for the procedure. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We may disclose your PHI in order to manage our group. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at one of our facilities.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the Hospital.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. Before we use or disclose medical information for research, the project will have been approved through a research approval process.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
For special purposes. We may disclose medical information about you for special purposes as permitted or required by law, including the following:
o Community and public health activities and reports such as disease control, abuse or neglect, and health and vital statistics.
o Administrative oversight for such things as audits, investigations, licensure, or determining cause of death.
o Court order or other legal processes related to law enforcement activities including custody of inmates, legal actions, or national security activities.
o Military and veteran reporting on members of the armed forces of U.S. or foreign military as required by military command authorities.
o Organ and tissue donation and transplant reports as required by regulatory organizations as necessary to facilitate organ or tissue donation and transplant.
o Workers’ compensation or other rehabilitative activities reporting as required by law or insurers in order to provide benefits for work-related or victim injuries or illnesses.
o Law enforcement if asked to do so by a law enforcement official:
To identify or locate a suspect, fugitive, material witness, or missing person;
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the Hospital; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
o Coroners, medical examiners and funeral directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Group to funeral directors as necessary to carry out their duties.
o National security and intelligence activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
o Protective services for the President and others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President or other authorized persons or foreign heads of state.
o Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary:
for the institution to provide you with health care;
to protect your health and safety or the health and safety of others; or
for the safety and security of the correctional institution.
Other Uses Of Health Information
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by the written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provide to you.
Your Rights Regarding Health Information About You
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to add a statement. To request an amendment, your request must be made in writing and submitted to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046. In addition, you must provide a reason that supports your request.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. We are not required by federal regulation to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046. We will not ask you the reason for your request.
Right to Paper Copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the Hospital. In addition, the next time you register at or are admitted to the Hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Arlington Family Practice, P.C. or with the Secretary of the Department of Health and Human Services. To file a complaint with the Arlington Family Practice, P.C., you must submit your complaint in writing to Arlington Family Practice, 22 Mill Street, Suite 101, Arlington, MA 02046. If you wish to discuss your complaint, you may call us at (781) 646-4345. You will not be penalized in any way for filing a complaint